title: Long-term evolution and prognostic stratification of biopsy-proven active myocarditis.
abstract: BACKGROUND
  Active myocarditis is characterized by large heterogeneity of clinical presentation and evolution. This study describes the characteristics and the long-term evolution of a large sample of patients with biopsy-proven active myocarditis, looking for accessible and valid early predictors of long-term prognosis.
  
  
  RESULTS
  From 1981 to 2009, 82 patients with biopsy-proven active myocarditis were consecutively enrolled and followed-up for 147±107 months. All patients underwent clinical and echocardiographic evaluation at baseline and at 6 months. At this time, improvement/normality of left ventricular ejection fraction (LVEF), defined as a LVEF increase > 20 percentage points or presence of LVEF≥50%, was assessed. At baseline, left ventricular dysfunction (LVEF<50%) and left atrium enlargement were independently associated with long-term heart transplantation-free survival, regardless of the clinical pattern of disease onset. At 6 months, improvement/normality of LVEF was observed in 53% of patients. Persistence of New York Heart Association III to IV classes, left atrium enlargement, and improvement/normality of LVEF at 6 months emerged as independent predictors of long-term outcome. Notably, the short-term reevaluation showed a significant incremental prognostic value in comparison with the baseline evaluation (baseline model versus 6 months model: area under the curve 0.79 versus 0.90, P=0.03).
  
  
  CONCLUSIONS
  Baseline left ventricular function is a marker for prognosis regardless of the clinical pattern of disease onset, and its reassessment at 6 months appears useful for assessing longer-term outcome.
authors.affiliation: Cardiovascular Department, "Ospedali Riuniti di Trieste" and University of Trieste, Trieste, Italy (M.A., M.M., G.S., G.B., G.F., B.P., A.S., A.P., G.S.); Cardiovascular Centre, Azienda per Servizi Sanitari no. 1 Triestina, Trieste, Italy (A.D.L.); Institute of Pathological Anatomy and Histology, "Ospedali Riuniti di Trieste" and University of Trieste, Trieste, Italy (R.B.); and Cardiovascular Centre Aalst, OLV Clinic, Aalst, Belgium (J.B.).
authors.forename: Marco
authors.initials: M
authors.lastname: Anzini
authors.forename: Marco
authors.initials: M
authors.lastname: Merlo
authors.forename: Gastone
authors.initials: G
authors.lastname: Sabbadini
authors.forename: Giulia
authors.initials: G
authors.lastname: Barbati
authors.forename: Gherardo
authors.initials: G
authors.lastname: Finocchiaro
authors.forename: Bruno
authors.initials: B
authors.lastname: Pinamonti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Salvi
authors.forename: Andrea
authors.initials: A
authors.lastname: Perkan
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.forename: Rossana
authors.initials: R
authors.lastname: Bussani
authors.forename: Jozef
authors.initials: J
authors.lastname: Bartunek
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
mesh_terms: D000208:Acute Disease; D000328:Adult; D001706:Biopsy; D006332:Cardiomegaly / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011379:Prognosis; D018487:Ventricular Dysfunction, Left / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology; D055815:Young Adult
keywords: biopsy; cardiomyopathies; follow-up studies; myocarditis